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Joint replacements

I have been working with several clients who have had joint replacements. I've seen hip, knee, ankle, and shoulder ones. I have a client who has had his Right hip and Left knee replaced and has many problems with a tight ITB and lateral thigh, especially after sitting for a few minutes. He is very active; golf, hikes, etc . He has excess motion with his Left tibia that whips his leg and I'm wondering if this has affected his Right hip.
Any thoughts?
Jody

Replies to This Discussion

Permalink Reply by Nancy L. Ring on September 5, 2009 at 9:31am

At a Kinesiological view point, I would say yes. Have you done any posture or gait on him? Have you tried Kinesio Taping around his knee? What treatments have you done? Sorry more questions than answers, but if I know what you have tried I may be able to help you find something that hasn't been done yet to improve his posture and gait.

Permalink Reply by Hans Albert Quistorff, LMP on September 6, 2009 at 12:04am

I also have several clients with joint replacements. I ave found that it takes extra "listening" to the reflexes that are called up to make up for muscle, tendon and ligament changes due to the surgery. I like to observe how they are able to maneuver a body ball with their heels while supine.
The right ITB is commonly used to shift the center of gravity over that leg. The cause could be the left knee or some other but the workout on the ball may be an avenue to balance and strengthen a more appropriate adaptation.
Thank you for starting the group and asking an interesting question.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist

Permalink Reply by Jody C. Hutchinson on September 8, 2009 at 9:18am

Thanks for the feed back. I haven't trained in Kinesiotape (yet) and am not the best at gait or posture. This client has ffot problems and his toes lack motion. He never stretches and has had lots of Physical Therapy. I have been treating him with MFR, Orthopedic Massage and NMT. While it has helped, I recently suggested that he try a foam roller on his ITB. He also commented that he may be "overdoing it a bit." hmmm. I also have noticed that many post surgery patients have high expectations and think that their injury will resolve quickly and permanently.
Thanks to all who have joined this group.
Cheers,
Jody H.

Permalink Reply by Carl W. Brown on September 22, 2009 at 7:01pm

Which ITB is tight? Often ITB together with adductors get tight protecting the knee.

Permalink Reply by Bert Davich on October 1, 2009 at 10:59am

Hello Jody,
You said something below that I consider a starting point that probably should be addressed first...... "This client has ffot problems and his toes lack motion". As long as his toes lack motion he will not be able to properly 'push off' his front arch. This results in a change of gait (limp) that will result in restrictions and contractions up the chain. The step forward will be shortened resulting in a lack of full knee extension and flexion ("dragging" the leg) affecting the Achilles tendon and other muscles used in dorsi flexion and plantar flexion in the lower leg. It will also affect posterior & anterior thigh muscles which will contract.
I would suggest that you first work to restore the front arch and free restrictions in the metatarsals as well as any other restrictions you can palpate or find by manipulating the foot into various positions including dorsi flexion, plantar flexion, inversion, eversion and combining those positions with a 'twist' (within the clients level of tolerance) in the foot. Then work your way up the chain. Check to see if the affected leg is being pulled into external rotation (of femur), common with contracted IT Band. If so you may need to address his hip rotators. If you do work the rotators, BE SURE you follow protocol regarding the hip replacement or you can cause a serious dislocation. And keep in mind that if he has had one hip replaced he may be a candidate for the other to be replaced.

Jody C. Hutchinson said:

Thanks for the feed back. I haven't trained in Kinesiotape (yet) and am not the best at gait or posture. This client has ffot problems and his toes lack motion. He never stretches and has had lots of Physical Therapy. I have been treating him with MFR, Orthopedic Massage and NMT. While it has helped, I recently suggested that he try a foam roller on his ITB. He also commented that he may be "overdoing it a bit." hmmm. I also have noticed that many post surgery patients have high expectations and think that their injury will resolve quickly and permanently.
Thanks to all who have joined this group.
Cheers,
Jody H.

Permalink Reply by megan harrell on March 4, 2010 at 3:29pm

Can anyone suggest articles, website or books that provide solid information on working with joint replacements? I have done some basic research, but I want more information to really help my clients.
I am currently working with a client who went in for a hip resurfacing, then 4 days later fractured the neck of the femur and had a full hip replacement. Two surgeries through the same incision in less than a week. After 4 weeks of PT a "muscle adhesion popped" and he regressed again. Now he is seeking massage to facilitate his recovery. I would appreciate any thoughts and/or references...
-Megan